Hepatitis E Virus Antibodies in Blood Donors, France

Abstract

Using a validated sensitive assay, we found hepatitis E virus (HEV) IgG in 52.5% of voluntary blood donors in southwestern France. This fi nding suggests HEV is highly endemic to this region. The high HEV prevalence may refl ect local dietary practices, such as eating uncooked pork and game products. It is now recognized that hepatitis E virus infection is not confi ned to developing countries. HEV infection is a growing public health concern in industrialized countries where the disease is mainly autochthonous, caused by HEV genotypes 3 (Europe) and 4 (People's Republic of China and Japan), and is thought to be zoonotic (1).In a previous study, we estimated that 16.6% of blood donors in the Midi-Pyrénées region of southwestern France have HEV antibodies (2). This rate was much higher than that measured in northern France (3), which suggests differences between these 2 populations and their exposure to HEV that we wished to explore further. However, it is diffi cult to make wider comparisons with seroprevalence studies from other areas because the various assays used differed in sensitivity and specifi city (4). Because a recent study suggested that the HEV IgG assay we used in our original study lacks sensitivity (5), we repeated and extended the study using a more sensitive assay that has been validated by using serum from PCR-proven HEV genotype 3 infections (5). The StudyDuring September 2003 through May 2004, serum samples were collected from 512 adult blood donors 18-64 years old (median 42 years) and 188 children 2-4 years old. The blood donors were unpaid voluntary donors; the children were hospitalized in Toulouse for surgery or trauma. All were residents of the Midi-Pyrénées region. The prevalence of HEV IgG was determined by using the Wantai HEV IgG enzyme immunoassay (Wantai Biologic Pharmacy Enterprise, Beijing, People's Republic of China), according to the manufacturer's instructions. Details of baseline demographic data and putative risk factors were collected from blood donors by using a structured questionnaire. In addition, to assess the risk for foodborne infection, we tested 18 local pig-liver sausages for HEV RNA using a quantitative real-time PCR based on the open reading frame 2 region of the HEV genome (6).HEV IgG was detected in 268 (52.5%) of 512 (95% confi dence interval [CI] 48.2%-56.8%) of the blood donors. Seroprevalence increased with age ( Figure 1). The ranges of optical density/cutoff ratios for positive and negative samples showed a clear bimodal distribution (Figure 2). Of 244 rural donors, 63.1% (95% CI 57%-69.2%) were anti-HEV positive compared with 42.9% (95% CI 37-48.8) of 268 urban donors (p<0.01). For children, seroprevalence was 3.7% (95% CI 1.0%-6.5%). The mean ± SD optical density/cutoff ratio of the positive samples was 5.43 ± 3.93 for children and 5.99 ± 3.52 for adults. Although several factors were associated with the presence of HEV IgG after univariate analysis, multivariate analysis identifi ed only age, rural residence, hunting, and contact with cats as factor...

Seroprevalence of Hepatitis E Virus in Autoimmune Hepatitis Patients in the Netherlands

“…Other studies have shown that the seroprevalence among the general population varies widely. Thus, while using the same antibody assay (Wantai) as employed in this study, a seroprevalence of 16% was found in a cohort of healthy donors in the south-west of the United Kingdom (n=500) [24], whereas this percentage was as high as 53% in south-western France (n=512) [21]. Our findings presented in this study are in line with these earlier observations.…”

“…The MP/Genelabs assay used in this study was also employed in a recent study in 7,072 Dutch samples collected in 2006 and 2007, in which a seroprevalence of only 2.6% was found [20]. When compared to the Wantai assay used in this study, the MP/Genelabs assay was shown to be considerably less sensitive in PCR-proven HEV cases which explains the considerable higher seroprevalence found in this study [21,22]. In the study by Pischke et al, in a subgroup of AIH patients (n=123) anti-HEV was tested using the Wantai assay.…”

Chronic Hepatitis E Virus Infection and Treatment

“…27 Thus, patients with an organ transplant are advised not to eat undercooked meat: HEV is only inactivated by temperatures >70 C. 28 In addition to the classical routes, HEV can be transmitted by blood transfusion, via the allograft, or by nosocomial transmission. Although, no case of HEV transmission via blood transfusion has been reported in the transplant population, 9 HEV seroprevalence in blood donors is high 29 and cases of HEV transmission via blood products have been reported in other populations. [30][31][32] Hence, if HEV infection is detected a few days after a blood transfusion, this mode of contamination should be investigated.…”

Hepatitis E virus in humans, farm animals and animals from the sylvatic environment

“…Częstotliwość występowania zakażeń u ludzi różni się w zależności od regionu świata. W Europie wynosi ona od 0,03% do 52% z najwyższym odsetkiem infekcji wśród osób pochodzących z terenów wiejskich, myśliwych lub mających kontakt ze zwierzętami uznanymi za rezerwuar wirusa (39). Seroprewalencja wzrasta wraz z wiekiem badanych osób i jest najwyższa (70%) w grupie pacjentów powyżej 58. roku życia (39).…”

“…Wyniki badań serologicznych prowadzonych wśród hodowców świń, lekarzy weterynarii oraz pracowników leśnych dowodzą częstszej obecności anty-HEV IgG u osób z tych grup zawodowych. Niemniej jednak nie obserwuje się gwałtownego wzrostu zachorowań osób zawodowo narażonych na kontakt ze zwierzętami (7,27,39,42,64).…”